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C.ertificnte of Completion <br />1. Name of Reci lent: 3. Pro'ect Nurnber: - <br />2. Grant Number: 4. Pro'cct Name: <br />5. Final Slatcment of Costs <br /> To Be Completed <br />B Reci Tent To Be Completed <br />B DCA <br />4 <br />Program Activity Categories <br />a Paid <br />Costs <br />b Unpaid <br />Costs <br />c "Total Costs <br />(Col. b + c) <br />d Approved <br />Total Costs <br />e <br />a. Ac uisition <br />b. Dis osition <br />c. Public facilities and im rovements <br />1 Senior and handica ed centers <br />2 Parks la rounds and recreation facilities _ <br />3 Nei hborhood facilities <br />4 Solid waste dis osal facilities <br />5 Fire rotection facilities and a ui ment <br />G Parkin facilities <br />7 Public utilities other than water and sewer <br />8 Water and sewer im rovements <br />9 Street im rovements <br />10 Flood and drama a irn rovements <br />11 Pedestrian im rovements <br />12 Other ublic facilities <br />13 Sewer im rovements <br />14 Water im rovements <br />d. Clearance activities <br />e. Public services <br />f. Relocation assistance <br />. Construction rehab. and reservation activities <br />] Construction or rehab. of com. & Indust. bld s. <br />2 Rrlrabilitation of rivatel owned builclin s <br />3 Rehabilitation of ublicl owned buildings - <br />4 Code enforcement <br />5 Historic reservation <br />h. Develo ment financin <br />1 Workin ca ital <br />2 Machine and a ui ment <br />i. Removal of architectural barriers <br />'. Other activities <br />k. Subtotal 341, 775 341, 77 <br />1. Plannin <br />m. Administration 36 720 ~ 36, 720 <br />n. Total <br />o. Less: Pro ram Income A lied to Pro ram Costs <br />. E ual: Grant Amount A lied to Pro .Costs 378,495 378,495 <br />6. Com utation of Grant Balance <br /> <br /> <br />Description To Be <br />Completed By <br />Reci tent To Be <br />Completed By <br />DCA <br />(a) <br />Amount <br />b Approved <br />Amount <br />c <br />1 Grant Amount A lied To Pre~ram Costs From Line <br />2 Estimated Amount For Unsettled Third -Part Claims <br />3 Subtotal <br />4 Grant Amount Per Grant A reement <br />5 Unutilized Grant To Be Canceled Line 4 Minus Line 3 <br />6 Grant Funds Received 378 495 <br />7 Balance of Grant Pa able Line 3 Minus Line 6 <br />* If Line 6 exceeds Line 3, enter the amount of the excess on Line 7,as a negative amount. This amount shall be <br />repaid to DCA by check, unless DCA has previously approved use of these funds. <br />